A school nurse is assessing a child who has diabetes mellitus. Which of the following findings should the nurse identify as a manifestation of hypoglycemia?

A. Place locks at the tops of exterior doors: Clients with Alzheimer’s disease are at high risk for wandering. Installing locks out of the client’s line of sight, such as at the tops of doors, enhances safety by reducing the chance of unsupervised exit.
B. Wear clothing with zippers instead of buttons: While simplifying clothing is helpful, Velcro or elastic waistbands are typically easier for clients with cognitive decline than zippers, which can still be difficult to manage.
C. Encourage physical activity prior to bedtime: Physical activity should be scheduled earlier in the day. Stimulating activity near bedtime may worsen sleep disturbances or contribute to sundowning in clients with Alzheimer’s disease.
D. Replace the carpet with hardwood floors: Removing carpet can increase the risk of slipping and falling. Soft flooring like carpet may actually provide better traction and cushion in the event of a fall.

Rationale for Correct Choices:

• Intravenous antibiotic: The client exhibits signs of postpartum infection, most consistent with endometritis—elevated WBC count, low-grade fever, uterine tenderness, foul-smelling lochia, and a history of prolonged rupture of membranes and cesarean delivery. IV antibiotics are the first-line treatment to control uterine infection and prevent sepsis.
• Increase in daily fluid intake: Maintaining adequate hydration is essential to support tissue perfusion and aid in the clearance of infection. Fever and elevated WBCs increase metabolic demands, so increased fluid intake can help mitigate dehydration and support antibiotic therapy.

Rationale for Incorrect Choices:

• Kleihauer-Betke test: This test detects fetal-to-maternal hemorrhage, typically used after trauma or suspected placental abruption. It is not indicated in cases of suspected postpartum infection.
• Intrauterine tamponade balloon: This intervention is used for managing postpartum hemorrhage due to uterine atony or trauma, not infection. The client’s bleeding is moderate and not indicative of uncontrolled hemorrhage.
• Tocolytic medication: Tocolytics are used to suppress premature labor and have no role in postpartum care, especially in the presence of infection, where uterine relaxation could worsen outcomes.